A biased look at psychology in the world

April 03, 2011

The Bedridden Activist (Part 2)

Aside from the health reforms and support for public nursing that were her main causes in life, Florence Nightingale also involved herself in a number of side causes, including economic reform to relieve poverty. She often cajoled legislators into passing legislation that she supported (both in terms of lending her support and threatening unfriendly politicans with adverse publicity if they failed to see things her way). Despite being a public figure, she remained an intensely private person and often preferred to act anonymously whenever possible. Her chronic illness (which remain undiagnosed during her lifetime) made her feel old before her time and, in her letters, she often described herself as elderly even at a relatively young age. Being an invalid didn't prevent her from caring for herself though and she often did many of her own household chores.

Florence Nightingale also never accepted payment for her activism and remained dependant on inherited money to support herself. This may have been one of the reasons for her adamant opposition to the registration of nurses (she considered nursing to be a calling rather than a profession). Arguing that nursing required a special aptitude that could not be effectively taught was not a popular position to take. Even after nursing registration became mandatory, she emphasized that nursing was continually evolving and encouraged lifelong learning so that nurses could keep their skills up to date. Her "Nightingale system of education" proved to be popular and she encouraged the founding of nursing schools throughout the British Empire and in the United States.

That wasn't to say that her life was entirely given to public service. She had a longstanding feud with the owner of a pub across the street from her modest home in London. The "disgraceful" behaviour of the pub's patrons and the noise of their antics which continued late into the night was a constant source of vexation for her. Florence Nightingale's status as a public heroine didn't seem to deter the pubowner and his customers in the least. Her strong Victorian attitudes regarding the evils of alcohol probably didn't help either. She was also an absolute perfectionist and insisted on cleanliness and order in her household and in the various homes and public building that she visited. Despite her strong views on many issues, she remained fiercely loyal to her small circle of family members and friends and often provided financial support when she could. She was also devoted to animal welfare (she owned cats all her life) and many of her surviving letters show her concern about the poor veterinary care available at the time.

By 1900, Florence Nightingale was completely blind and more dependent on her personal staff than ever. When financial problems forced her to "retrench" and let her nurse go, it was a personal blow for her but she managed to live her remaining years in comfort. For the last ten years of her life, she was an almost total invalid with little real writing completed. Her memory had become so poor that she needed to be briefed on any new visitor that she received. The India Office was instructed to stop sending her material in 1906 since she could no longer understand them. When Florence Nightingale died on August 13, 1910, she left behind an amazing legacy of public service and writing (although many of her papers were destroyed at her death as she had requested). While she also left behind instructions that her body be used for medical research, her wishes were ignored and she was buried in her family church in East Wellow. The grave marker simply states, "F.N. Born 12 May 1820, Died 13 August 1910.”

Aside from her achievements, Florence Nightingale also left behind a medical mystery. What was the disease that left her an invalid for much of her life? Given the lack of proper diagnostic tests at the time and the variable nature of her symptoms, many of her later biographers suggested that her illness was largely psychosomatic. Given the number of soldiers in her care who had died as a direct result of her reluctance to recognize the need for proper sanitation (which she freely admitted in her commission work), the theory that her symptoms stemmed from depression became popular for a time. Even up to 1899, the Encyclopedia Britannica article on her stated that "it has never been shown that Florence Nightingale had any organic illness; her invalidism may have been partly neurotic and partly intentional." Her tendency to worsen whenever she experienced emotional turmoil also resulted in accusations of deliberate malingering (she was often referred to as a "strategic invalid").

The current medical consensus seems to be that her symptoms stemmed from a serious attack of brucellosis (also known as "Crimean fever") during her time in Turkey. Believed to be the result of her exposure to infected meat or unsterilized milk, the acute phase of the disease can be marked by severe headaches, anemia, depression, and weakness. Although she recovered enough to carry on her nursing work, the damage left behind by the disease would stay with her for the rest of her life. Considering that brucellosis is still rare in industrialized countries, it's hardly surprising that her condition was never properly diagnosed in her lifetime. There has also been speculation that she suffered from chronic fatigue syndrome or myalgic encephalomyelitis and the Nightingale Research Foundation continues to fund research into those two diseases in her name.

Whatever the actual diagnosis, there is no doubt that Florence Nightingale's ability to carry on her reform work while dealing with such a debilitating disease remains inspirational. The annual International Nurses Day is stll celebrated each year on her birthday.

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I had forgotten about Nightingale until stumbling upon this and had the thought what life would be like if more people had her complete disregard for self (although the assertions about her being a 'convenient invalid' are really intersting and something I hadn't heard before). Can't help but wonder what kind of impact she'd have on the current health care debate. in my opinion there aren't many voices like this currently that cut through the budget talk, etc. that seem to dominate the conversation. Anyhow, appreciate the post.